By Emily Roberts

The Mediterranean Diet is based on the eating patterns in the Mediterranean region and focuses on fruits, vegetables, fish, whole grains and healthy fats (1).  A diet not invented, but discovered, is now recognized as one of the healthiest dietary patterns (2). UNESO defines it as “a social practice based on all the “savoir-faire”, knowledge, traditions ranging from the landscape to the table and covering the Mediterranean Basin, cultures, harvesting, fishing, conservation, processing, preparation, cooking and in particular the way we consume” (3). The Mediterranean region is considered the Mediterranean Basin that borders the Mediterranean Sea and includes parts of seven countries: France, Portugal, Italy, Spain, Greece, Malta and Cyprus (4). There have been foreseen health benefits of consuming this diet, classifying it as “heart healthy” due to its likelihood to reduce the risk for heart disease (5,6). Living on the southern coast of France, I not only experience the Mediterranean lifestyle, but I have the opportunity to consume a Mediterranean Diet.

The Discovery

The Mediterranean Diet was discovered to have particular health benefits by Ancel Keys of the University of Minnesota in the 1950’s. He happened upon this discovery while studying the health of poor populations in Southern Italy in comparison to the wealthy in New York. He found the Italian populations had lower levels of cholesterol and a low rate of coronary heart disease (1).

Typical Foods

The diet is full of fresh foods including fruits, vegetables, herbs, fish, olive oil, breads, nuts and pastas (1). There is a very low consumption of red meats, poultry, butter, refined grains and processed foods. The diet is rich in fiber, monounsaturated fats and polyunsaturated fats, antioxidant compounds, and essential vitamins and minerals; conversely, it is very low in saturated fats. Given the diet’s composition of nutrient dense foods, strong adherence to this diet is associated with improved nutritional adequacy (2).

The Benefits

A strong adherence to the Mediterranean Diet enhances the chances of improving your health status. It has been found to reduce the risk for mortality, especially due to cardiovascular disease (7). There have been many cohort studies conducted in the Mediterranean Basin often showing good adherence to the diet and resulting in reduced incidence for cardiovascular events (6). The benefits of the diet are likely to improve with physical activity as well, such as decreased blood levels of LDL (1).

My observations

During my time in the south of France I have noticed the influence the agriculture and natural resources of the Mediterranean Basin has on the cuisine. This area is rich in olive groves, offering a plentiful supply of fresh olive products. The sea offers fresh fish, shellfish and other seafood, while local markets sell fresh fruits and vegetables. Cattle farms are not as populous in this area, so the consumption of red meat and butter is not as high as other European regions (such as Northern France). However, considering I am still residing in France, pastries, baguettes, and of course cheese are a typical part of the French dietary meal pattern. This differentiates my diet somewhat from other Mediterranean regions. Thankfully, walking as a means of transport is very common if not necessary, offering an efficient form of daily exercise. Fresh and homemade are the two words that best describe home cooking near the Mediterranean.  While residing with a local French family, I ate many freshly prepared meals. Everything made from scratch from salad dressings to whole grain bread.

The Mediterranean Diet is not an effort, rather a daily practice for many Europeans. As Americans, we may recommend it as a diet intervention or integrate it into our own eating habits for health reasons. This diet is seen to be successful by offering significant health benefits. This encourages me to try various diets from around the world that could potentially provide various health benefits for Americans, as well as a taste of a new culture.

1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684452/

3.La DiÈte MÉditerranÉenne 2010. Candidature transnationale en vue de l’inscription sur la Liste ReprÉsentative du Patrimoine Culturel ImmatÉriel de l’HumanitÉ. Espagne / GrÈce / Italie/Maroc, Version Informations Additionnelles.

By: R. Alex Coots

The field of nutrition is diverse. Some nutrition researchers pursue their work to better understand human metabolism, while others seek to help people build healthy eating habits. Despite the different approaches in their research programs, nutrition researchersall aim to improve public health. But simply producing the information isn’t enough. The entirety of scientific knowledge must be evaluated and used to create effective policies to fully realize the benefits of nutrition research.

Angela Tagtow, Executive Director of the Center for Nutrition Policy and Promotion at the USDA, continues an illustrious career in health promotion at the USDA. She’s worked in nutrition, public health and food systems at levels ranging from local initiatives to international endeavors. She and I had a conversation about her career, her advice for students interested in policy, and her thoughts on the challenges of policy work.

How did you get your start in nutrition and policy?

Growing up, food and meals were very important in my family. We maintained a large garden which provided diverse foods for our day-to-day meals. In college I had an intense interest in health promotion, but clinical dietetics was focused on treatment rather than prevention of illness. Health promotion at the time was nascent but I saw the potential and oriented my life towards it.

After graduation from college I started work at the American Heart Association as a program director. This position helped build out my network and gave me my start in the health promotion world, however I quickly realized I’d need graduate-level training to take my career further. After graduate school I started work as a consultant in the WIC program at the Iowa Department of Public Health. Here I worked more broadly in the public health domain with a variety of groups such as the county boards of health and Title V Maternal and Child Health Services.

After 9 years, I decided to expand my areas of expertise to include food systems as well as public health and nutrition. I founded a consulting company where I provided education, informed policy, and developed communication tools around health, the environment, and food systems. After 9 years of consulting, I moved back to government to work at the CNPP.

What are the key lessons or skills that you took away from these endeavors?

Consulting work affords you a good deal of flexibility in the types of work that you take on. I was able to broaden my skillsets, increase my knowledge base, and diversify my network in ways that I wouldn’t have been afforded in government. Consulting does have a bit more uncertainty with respect to job security. A career in government is a much different experience. The scope of the work is more defined and the position is more secure compared to consulting, but it may be difficult to advance upward.

The key skillsets that today’s students should focus on are critical thinking, communication, and engagement. As dietitians and nutritionists, we need to feel comfortable being assertive and asking the difficult questions. Of these three skills, engagement and networking are the hardest to teach. Students should continually practice this skill throughout their careers. Networking is something that takes time and is an ongoing learning experience.

When creating nutrition policy, are particular data or data types more useful than others?

All of the different data types must be considered, especially systematic reviews and randomly controlled trials. We need to be looking at the preponderance of data to reach a conclusion, not create policy based on one particular study or study type, as each type of study has strengths and weaknesses. After evaluation of the data, we have to be able to translate the body of research into appropriate policy or interventions. Policy is like a puzzle and data are the pieces.

Do you feel that there’s siloing of academic fields, and that crosstalk can improve health outcomes?

There’s still some siloing of research topics, but there has been improvement. Some land grant institutions with great agricultural research programs focus on food production or food processing issues, but this work is not necessarily connected to the greater picture of human health. Some schools have recognized this issue and have started interdisciplinary programs aimed towards interconnectivity – programs in food systems is a good example. People have recognized the value of an integrated approach, but it’s a process that takes time to develop.

Read Part 2 of this interview.

By: Mary Scourboutakos

In just a few weeks, New York will be the first city to introduce high sodium warning labels in restaurants. As a result, come December 1st 2015, any menu item that exceeds 2300 mg of sodium will be required to sport the new graphic illustrating a salt shaker inside of a triangle.

The policy, which is an amendment to the New York City Health Code, will affect any chain restaurant with at least fifteen locations, and will affect over 3000 restaurants, or one-third of all restaurant traffic in New York City.

Megan Lent, the Acting Director of Policy at the Bureau of Chronic Disease Prevention and Tobacco Control, who was involved in the background research and development of the policy, said the idea came from research which showed that people are eating more of their meals away from home. Furthermore, she said the rationale also comes from sodium’s effect on blood pressure, and ultimately heart disease—which is the leading cause of death in New York City. Hence, she explained that this policy will “put information back into consumers hands” and thus hopefully foster healthier choices.

While some might argue that 1500 mg—the daily Adequate Intake level—would be a more conservative limit, Lent says they went with 2300 mg—the daily Upper Tolerable intake level—because “this clearly lets people know when they’ve reached that threshold, without making assumptions.”

As for the choice of a pictorial warning label, Lent explained that listing the number of milligrams of sodium is preempted by the federal calorie labeling law that was passed as part of the Patient Protection and Affordable Care Act, back in 2010. Hence, numerical information regarding sodium simply isn’t allowed. Nevertheless, as Lent highlighted, one advantage of the graphic is that it provides an “actionable symbol.”

The implementation of policies such as this one, rarely come without backlash from critics. However, while this policy did receive some comments from the food industry during the public comment period, Lent explained that with regards to the media coverage “a lot has been fairly supportive.” And while some experts have criticized the whole notion of menu-labeling, citing a lack of evidence of effectiveness, Lent says polling has shown that “many New Yorkers think calorie labeling is useful and that these interventions are helpful.”

In a recent article posted on Nation’s Nutrition News, Anita-Jones Mueller, the founder of Healthy Dining and Healthydiningfinder.com, told industry to “just say no” by stating “save money and time, and prevent the risk of disappointed guests, by saying NO to the icon and making sure that most — if not all — of your menu items contain under 2,300 mg of sodium. It’s possible!”

But is it possible? In my own research, I’ve found that 56% of meals from chain, sit-down restaurants would qualify for the warning label, if it was implemented in Canada. However, when menu items are listed individually on the menu (ex. side dishes separate from entrÉes) only 9% would carry the label.

The New York Department of Health plans to evaluate the policy by monitoring changes in sodium levels over time using “Menu Stat”, their free online longitudinal nutrition database containing information for thousands of restaurant foods. But will the policy encourage decreases in sodium, as was seen in King County, Washington after the implementation of their sodium labelling policy? One can only hope!

By Emily Roberts

The United States is able to utilize government assistance to support various programs to help improve the nutritional status of our nation. There is a safety net of several programs to improve public health via nutrition. Prolonged consequences of an unhealthy lifestyle including obesity, heart disease and type II diabetes are being seen in other countries as well. As I am currently residing in the south of France for seven months to teach English, I have the opportunity to discover how another country is tackling the public health problems associated with nutrition.

Chronic Diseases in France

Worldwide we are seeing an increase rate of health disparities. Cardiovascular disease, obesity and type II diabetes are three main common ailments and are often preventable. Cardiovascular disease is the leading cause of death worldwide (1). Now in the 21st century over 30% of the world’s population suffers from heart disease. Interestingly enough in France, heart disease mortality isn’t as high as other 1st world countries (2). Despite a diet rich in saturated fats and cholesterol, the incidence of heart disease remains low (3). While heart disease may not been the main concern, circulatory disease remains an issue, being the second leading cause of death in 2012 after cancer (2). In 2014 25.7% of the French adult population was obese (4). Comparing this to the United States at 35% they aren’t too far behind (5). Type II diabetes is drawing attention as well as a health issue. In 2009 7.0%- 7.5% of the French population had type II diabetes in comparison to about 10.41% of the United States Population (6,7). France is addressing currently addressing these problems and taking on tactics similar to the United States by promoting preventative methods.

Le Programme National Nutrition SantÉ (PNNS)

Manger Bouger translates to Eat and Move. It is supported by Programme National Nutrition SantÉ (PNNS) meaning a national nutrition and health program (8). PNNS began in 2001 with the objective to improve public health and reduce the incidence of chronic diseases by improving nutritional practices. The goals of PNNS assess different social, cultural, cognitive and economic disparities when trying to improve the nutritional status and the level of physical activity of France. Under the umbrella of PNNS there are a few specific programs. In 2010, the French government has implemented un plan obÉsitÉ (PO) (an obesity plan) and also un programme national pour l’alimentation (PNA) (a national food program).

Manger Bouger

Similar to the US’s ChooseMyPlate, the Manger Bouger site offers a plethora of helpful nutritional information to the public (9,10). It stresses to regularly eat a diet mixed in fruits, vegetables, grains and fish; limit salts, sugars and fats and to participate in regular physical activity (10). It explains to the public how these healthy lifestyle choices can reduce your risk for many chronic ailments. The site also briefly mentions to read nutrition facts labels, but there is little assistance on how to understand this information. Furthermore, the format for Nutrition Facts in France is very different and hard to interpret given the main point that there are often no serving size portions and only 100g portion sizes. While, there is no software on the site similar to SuperTracker or any type of diet assessment tool, there is La Fabrique à Menus, which helps to plan out a daily menu of various healthy dishes. Manger Bouger also includes a blog titled “Le Mag” which includes tips on how to enjoy the many rich flavors of France or eating on a budget, while still eating healthy.

My experience

Living in France, I have witnessed how important cuisine is to the French population. A prime example is how each region has traditional dishes tied closely to their culture. In Nice a popular dish is socca, a chickpea pancake, and in SÈte you cannot walk a block without finding tielle, a savory fish tart. Manger Bouger embraces this by providing general nutritional practices like consuming smaller portions, while keeping the tradition of French cuisine alive. Manger Bouger only offers specific meal advice for lunch and dinner (11). This is most likely because a typical French breakfast or petit dÉjeuner is only a slice of bread or a croissant and a coffee. Snacking in France is also less common. While in America five small meals a day can be seen as a healthy eating habit, this would not be ideal for the French as they value their meal time as a time to relax and experience their food. Unfortunately, the French do not seem to draw much attention to the specific nutritional content of their food. Consequently the general public does not seem as well educated on their daily caloric intake and the nutritional makeup. This could be due to the fact that they seem to focus more on reducing portion sizes and over eating rather than changing the composition of their diet.

1.https://www.who.int/mediacentre/factsheets/fs317/en/

2.https://ec.europa.eu/eurostat/statistics-explained/index.php/File:Causes_of_death_%E2%80%94_standardised_death_rate,_2012_%28per_100_000_inhabitants%29_YB15.png

3.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768013/

4.https://www.cia.gov/library/publications/the-world-factbook/geos/fr.html

5.https://www.cia.gov/library/publications/the-world-factbook/geos/us.html

6.https://www.changingdiabetesbarometer.com/diabetes-data/countries/France/fact-sheet.aspx

7.https://www.changingdiabetesbarometer.com/diabetes-data/countries/usa.aspx

8.https://www.mangerbouger.fr/pnns/le-pnns-c-est-quoi.html

9.https://www.choosemyplate.gov/about

10.https://www.mangerbouger.fr

11.https://www.mangerbouger.fr/bien-manger/la-fabrique-a-menus.html#menu

12.https://ec.europa.eu/eurostat/statistics-explained/index.php/Causes_of_death_statistics#Further_Eurostat_information

13.https://www.euro.who.int/__data/assets/pdf_file/0004/185215/Leading-causes-of-death-in-Europe-Fact-Sheet.pdf

By Marion Roche, PhD

Approximately 162 million children are stunted.In the global nutrition community the human costs of stunting are well recognized: stunted children complete less school, have less learning and earning opportunities, and females who become moms in the future are more likely to give birth to stunted children. Intervening early in 1000-day window (from conception to the age of two) and even earlier, pre-pregnancy, is recognized as most cost-effective way to prevent, as in many settings it challenging to reverse the physical and cognitive deficits from chronic malnutrition. Beyond the human costs, there is also an economic case to be made for investing in stunting reduction.

Every four years, the world’s leading economists and experts from diverse development fields come together to rank the best investments for development in what is called the Copenhagen Consensus. Nutrition is one such investment that is consistently ranked as a “best buy”. Specific interventions such as vitamin A supplementation, salt iodization, zinc & ORS for diarrhea treatment and support for breastfeeding and adequate complementary feeding have all been in the top 10 best investments in previous years. In addition, nutrition-sensitive approaches, such as keeping girls in school, improvements to agriculture yields and crop quality, enabling gender equity for women, and overall poverty reduction, are all necessary to sustainable long-term stunting reductions for communities and countries.

This month, world leaders and experts met in Addis Ababa, Ethiopia for the Third International Financing for Development conference. A presentation by Dr. Meera Shekar of the World Bank and Dr. Robert Hetch of Results for Development at an MI co-hosted side-event on nutrition at the conference laid out what it would take to achieve the World Health Assembly target of reducing stunting by 40% by 2025. They emphasized that strategic investing in improving the nutrition situation for 68 million children would offer a long-term $45 dollar return on each dollar invested. More specifically, every dollar invested in reducing stunting is estimated to generate an $18 return in the long run. However, although many nutrition interventions look affordable on an individual scale, a more detailed analysis has been done to show what it would cost to deliver these interventions and reduce stunting at a global scale.

The Financing for Development conference was centred on funding the Sustainable Development Goals, the set of targets relating to the of future international development post-2015. Looking at the return on investment (ROI) in nutrition and knowing that nutrition has such a profound effect on other areas of a person’s life, I think there is no better investment the world can make to reach the SDGs more quickly and effectively than that in nutrition!

By Hassan S Dashti, PhD

When we describe our habitual diets, we often find ourselves talking about its nutritional composition (i.e. what) and quantity (i.e. how much), however novel research suggests that timing of intake might be yet another important component of diet we want to pay attention to. This was the main focus of discussion at the ASN Scientific Sessions at EB 2015 symposium titled, “Is ‘When’ We Eat as Important as ‘What’ We Eat? – Chronobiological Aspects of Food Intake” (read more here: https://www.nutrition.org/asn-blog/2015/04/timing-is-everything/). Biologically, this makes sense as an endogenous clock, commonly termed the circadian clock, regulates a constellation of biologic processes, including metabolism (1). If up to 30 percent of genes in the intestines, liver, and kidney fluctuate throughout the day, yielding varying temporal functional profiles, doesn’t it make sense that there ought to be a time when dietary intake is optimal? Well, if the effect of a calorie on health is dependent on timing, what we all would like to know next is at what time should we be eating?

What currently determines our timing of intake is our culture and lifestyle for the most part. For instance, kids’ lunchtime is predetermined by school cafeterias, adults’ dinnertime is predetermined by rush-hour traffic, but even breakfast also seems to determine when we’ll have our next meal, lunch (2). History also played a role in determining meal times. In certain parts of the world, lunchtime was set for noon to enable workers to cope with long working hours in factories during the Industrial revolution. Perhaps it’s time to have science determine our meal hours.

Preliminary evidence suggests that earlier meal times tend to be healthier and “better aligned” with our biological clock. In one study, it was found that calories consumed after 8:00pm significantly predicted higher BMI (3). Meanwhile results from a 20-week weight loss intervention among overweight and obese individuals suggested that late eaters (lunch after 3:00pm) were less successful at weight loss compared to early eaters (lunch before 3:00pm), independent of 24-hour energy intake (4). Another trial assessing overweight and obese women further identified that high-calorie breakfasts, as opposed to high calorie dinners, were more beneficial for various cardiometabolic traits (5). Consistent with the findings from these trials is a cross-sectional analysis of a diverse cohort in the Los Angeles area that suggested that participants who consumed over a third of their calories by noon were less likely to be overweight and obese (6).

While these findings generally suggest that earlier hours of intake are generally healthier, they are not without their many limitations. One limitation worth noting is the high interrelatedness between timing of intake and other aspects of diet and life that also impact overall health and particularly sleep timing and duration, frequency of intake, and hours of fasting. Therefore, future studies should account for these strongly related dimensions when elucidating the timing of intake that best aligns with our internal clock.

1.Garaulet M, Gómez-Abellán P. Timing of food intake and obesity: a novel association. Physiol Behav. 2014 Jul;134:44–50.
2.Kant AK, Graubard BI. Within-person comparison of eating behaviors, time of eating, and dietary intake on days with and without breakfast: NHANES 2005-2010. Am J Clin Nutr. 2015 Sep;102(3):661–70.
3.Baron KG, Reid KJ, Kern AS, Zee PC. Role of sleep timing in caloric intake and BMI. Obesity (Silver Spring). 2011 Jul;19(7):1374–81.
4.Garaulet M, Gómez-Abellán P, Alburquerque-BÉjar JJ, Lee Y-C, Ordovás JM, Scheer FAJL. Timing of food intake predicts weight loss effectiveness. Int J Obes (Lond). 2013 Apr;37(4):604–11.
5.Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity (Silver Spring). 2013 Dec;21(12):2504–12.
6.Wang JB, Patterson RE, Ang A, Emond JA, Shetty N, Arab L. Timing of energy intake during the day is associated with the risk of obesity in adults. J Hum Nutr Diet. 2014 Apr;27 Suppl 2:255–62.

By Amber Furrer, MS

The term “food security” at a basic level was defined by the World Food Summit of 1996 as “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life” (FAO 1996). This is obviously a key element in success and well-being of any people, though its realization will look a little bit different in America, where we do still have food insecure, compared to other parts of the world.

There are many facets to the problem: poor infrastructure and organization, poverty, limited education, social injustice and gender inequality, conflict, and lack of natural resources. Solutions also cannot generally be broadly applied because each country experiences these issues differently. Despite the successes of the Green Revolution in agriculture and food research implementation and nutrition interventions since the 1960’s, around 850 million people (or about 15% of the world’s population) remain malnourished. For children specifically, this jumps to 20%. The enormity of the problem can leave a person wondering what possible difference one person or one organization could make.

On May 8, I traveled to Uganda on 3-week assignment with a United States-based NGO whose mission is to serve the vulnerable in developing countries with development and relief efforts. Uganda, like the surrounding countries, is given a “low human development” score in the 2014 Human Development Report by the United Nations. In 2006, 38% of Ugandan children experienced chronic malnutrition, or stunting. Vitamin A and iron deficiency remain critical problems in population health, especially for mother and children (FAO 2010)

The broad focus of my assignment was nutrition education and recipe development for a small-holder farmer cooperative. In general, farmers are an important target for nutrition education because they are able to impact the local food supply and most farmers are women of reproductive age.
Preparing for my trip, I wasn’t sure what kind of impact I would have. A semi-tropical climate allows Ugandans to grow and consume a variety of foods, and on paper I thought their diet seemed pretty adequate. But of course things on paper are always a bit different than what you find in reality.

I spent two days with each group of farmers, the first day communicating (through a translator) the basic, important concepts of nutrition and the second explaining and demonstrating foods and preparation methods that could improve the diet quality of people in their district. I shared the kind of information that we take for granted: the role of carbohydrates, protein, fat, vitamins, and minerals in our bodies and the importance of consuming a balanced diet including a variety of foods in addition to other simple but important tidbits like “don’t feed tea and coffee to your children.” When it came to recipe demonstrations, I explained things that most people in the US could look up on a computer whenever they wanted, but for these women and men was not accessible.

Along the way, I began to recognize that consumption patterns, while related to economic factors, often have more to do with cultural practices and preferences and societal barriers. A visitor to Uganda immediately notices the huge amount of carbohydrate sources consumed at every meal. There are several, including Irish potatoes, (white) sweet potatoes, cassava, green banana, rice, corn and millet-based pastes, and wheat-based chapatti. Ugandans also grow a variety of beans, ground and tree nuts, vegetables, and fruits, so it is not that nutritious foods are totally absent, but are consumed in skewed proportions.

Fruit is considered child’s food, and vegetables (including beans) are consumed in very small amounts. Meat, dairy, and eggs are not widely affordable, and insects and fish have an undesirable “poor food” stigma attached. Influences and perceptions of a Western diet have made white bread and other packaged foods sought-after commodities, rather than the native whole grain millet, avocadoes, mangos, and other naturally nutritious foods that Americans are ironically trending towards.

In lacking a strong education system and broad computer access, Ugandan people live in an information desert. Despite the agricultural potential for variety, many dishes are made and consumed the same way day after day with the same ingredients because knowledge on nutrition and food preparation is lacking. There are countries with enough conflict and natural resource struggles that educating on the benefits of vegetable and dairy/animal protein consumption might be a moot point, but in Uganda these things are more achievable. Timing seems critical: these farmers were at a point where they requested this training, and that makes the potential impact far greater.

Easily-modified agricultural factors can have broad influence on the diet. For example, simple introduction of orange-fleshed, rather than white-fleshed, sweet potatoes can vastly improve vitamin A intake. Increasing use of fertilizers or crop rotation practices can ensure that minerals which foods like peanuts should theoretically contain are actually present.
Gender-related issues can also impact diet quality. Women are responsible for feeding themselves and their children, but the money, even money they earned, is not always in their hands. Men may have a nice meal at a restaurant while women eat cassava and potatoes at home. In addition, the common practice of multiple wives and the perception of children as a status symbol often make families quite large.

Overall, while economic, agricultural, and societal factors do play a role in food security, in countries such as Uganda I think nutrition education has strong potential to directly provide needed knowledge and indirectly change practices and prejudices that impede diet quality. My personal experience fully supports UNICEF recommendations for future nutrition education programs, including starting young, investing in women and girls, and collaborating across ministries to support integrated approaches to improving the diet (Unicef 2014). These integrated approaches address other strong nutrition influencers such as food safety and hygiene and health and disease, in addition to agricultural production.

FAO. 1996. “Declaration on World Food Security.” World Food Summit, Rome: FAO.
FAO. 2010. “Uganda.” United Nations. https://www.fao.org/ag/AGN/nutrition/uga_en.stm
Unicef. 2014. “Multi-Sectoral Approaches to Nutrition: The Case for Investment by Educational Programmes.” https://www.unicef.org/eapro/Brief_Education_Nutrition.pdf

By Sheela Sinharoy

As the tragedy of the earthquake in Nepal continues to unfold, we see images of disaster response teams at work. How does assistance reach those who need it, especially in terms of meeting the food security and nutrition needs of the affected population?

In general, humanitarian response is led by the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA). OCHA uses a cluster approach; in Nepal, the nutrition cluster is jointly led by the Ministry of Health and Population (MoHP) and UNICEF. Other UN agencies (e.g., World Food Programme), bilateral organizations (e.g., United States Agency for International Development or USAID), and non-governmental organizations (e.g., CARE) are all members of the cluster. In many countries, the cluster has regular meetings so that coordination and communication mechanisms are already in place before a disaster strikes.

Each cluster follows the guidance in The Sphere Handbook, which outlines minimum standards in the areas of water supply, sanitation and hygiene promotion; food security and nutrition; shelter, settlement and non-food items; and health. This handbook represents the contributions of many humanitarian agencies and is meant to have universal application to any humanitarian response. It particularly emphasizes affected populations’ right to dignity, protection, and assistance and promotes their active participation as a way to ensure the appropriateness and quality of the response.

The food security and nutrition section of the handbook includes standards for the protection of safe and optimal infant and young child feeding, management of acute malnutrition and micronutrient deficiencies, and food security. It states that food rations should meet the following nutrition requirements: 2,100 kcals per person per day, 10% of total energy provided by protein, 17% of total energy provided by fat, and adequate micronutrient intake. If the affected population has access to some food, then the ration should aim to fill the gap between what people can access and the nutrition requirements. There are many other considerations outlined in the handbook, including the cultural acceptability of the food ration and the ability of the affected population to store and prepare the foods.

According to the May 1, 2015 Nepal situation report issued by OCHA, more than 3 million people require food assistance. In line with The Sphere Handbook, the nutrition cluster has decided to standardize food assistance to include 400g rice, 60g lentils, 25g oil, and 7.5g iodized salt per person per day. Some of the food comes from in-country supplies, and some is brought in from other countries in the region. WFP, as lead of the logistics cluster in Nepal, manages this and has dispatched trucks and, in some cases, helicopters to carry food and other supplies to priority areas.

Disasters such as the earthquake in Nepal require an immediate expert response. OCHA and the nutrition cluster, by following The Sphere Handbook, are working to protect the nutrition of the affected populations in the most effective way possible.

By Teresa Johnson, MSPH, RD

Robert Waterland, PhD, an associate professor at Baylor College of Medicine, described nutritional influences on human developmental epigenetics. Waterland defined epigenetics as “mitotically heritable stable alterations in gene expression potential that are not caused by changes in DNA sequence.” Multiple factors likely contribute to epigenetic changes, including cytosine methylation, histone modification, auto-regulatory transcription factors, and non-coding RNAs, Waterland pointed out, and they tend to work in a synergistic fashion to influence gene transcription. Waterland said he is particularly interested in DNA methylation because methylation requires dietary donors and cofactors, which is influenced by nutritional factors. He presented data demonstrating that periconceptual maternal nutrition status predicts hypomethylation in a mother’s infant. These changes are stable and maintained over a lifetime, Waterland said, and may point to evidence of metabolic imprinting as an adaptive response to early nutrition.

“We live in a microbial world,” said Dingding An, PhD, a researcher at Boston Children’s Hospital. An elaborated on the role of early life gut microflora in immune system development, and explained that microbial exposure begins at birth and influences our risk for chronic diseases such as inflammatory bowel disease, asthma, arthritis, and autism later in life. Many early-life factors impact the makeup of the gut microbial population in particular, such as nutrition, hygiene, and antibiotic use. An presented data indicating that some gut microbes enhance immune cell maturation and immune response. But the timing of microbial exposure is critical, An added, because later exposure diminishes the response, indicating that key windows of regulation have been missed.

Deborah Sloboda, PhD, an associate professor at McMaster University, provided insights into the impacts of fructose consumption during pregnancy. Fructose is a monosaccharide present in honey, maple syrup, and fruit sugar, and is widely available in processed foods. Fructose consumption differs by sex and age, Sloboda said, with highest consumption reported among lower socioeconomic status females during their reproductive years. This is important, Sloboda said, because “the early-life environment plays a very big role in determining health and disease risk later in life.” Her data from animal models indicate that high fructose intake during pregnancy induces changes in the offspring’s metabolic response. Taurine supplementation reversed fructose-induced adverse metabolic programming, Sloboda said, but not in the presence of a high fat diet, emphasizing the importance of correctly identifying the population in need of intervention.

Growing up in the now well-studied Swedish village Överkalix strongly influenced the research of Lars Bygren, MD, PhD, a professor at University of Umea. Bygren, who addressed the topic of transgenerational outcomes associated with paternal nutrition, explained that human responses to early-life exposures, especially in males, have the potential to impact development for multiple generations. In particular, exposure to high food availability during slow-growth periods negatively affects the health of subsequent generations, and could explain the present day prevalence of many chronic diseases. Byrgen said data from other studies, including the Taiwan betel nut study and the ALSCAP study, lend support to these conclusions.

By Brett Loman

Americans are more aware of what we are eating than ever before, but how we choose to track this information varies quite a lot. Some simply choose to eat more or less of a specific type of food while others record every single thing that they consume. In light of this, I decided to give a few programs a test run. I’ve rated them with 3 stars being the highest.

SuperTracker **½ overall
(free online tool, part of the MyPlate website published by the USDA)
At first impression I was overwhelmed by the multitude of –initially- empty tables and graphs. Once I got into the swing of things, however, my concerns transformed into amusement.
Ease of Use – **
While only be accessed through a web browser, the mobile site is an apt adaptation of the desktop version. Searching for each food is simple enough, but things get cumbersome when selecting the number of units. There is a multitude of units to choose from (e.g. fluid ounces, grams, slices, etc) but the number of those units is limited to a select few choices in a drop down menu.
Foods Available – **
Only some name brands and restaurants are available as choices. However, I could build the majority of complex foods using the basic selections that were available.
Nutrient Information ***
I was surprised by how much detailed information this program offers. Nearly every macronutrient, vitamin, and mineral was addressed in the “Nutrients Report”. This report offers target and average intake side-by-side plus expandable menus that explain which foods contributed (and by what percentage) to that nutrient’s intake.
Recommendation Information – ***
This is where the graphics are exceptionally helpful. They compare my intake to recommendations on the basis of food groups (broken down into things such as refined versus whole grains), empty calories, and individual nutrients.

MyDietAnalysis **overall
(subscription-based website provided by Pearson)
It happens to be the tracker utilized by my university’s introductory nutrition course, so naturally I had to give it a try.
Ease of Use – *
It is only available through a web browser, and the mobile site was not very user-friendly. Commonly chosen foods were under a completely separate menu unhelpfully named “Fast Entry” and only 7 days of intake could be store at one time.
Foods Available – ***
This program has the most specific food items I have seen in a tracker program. Most of the major chain restaurant and grocery brands are represented, cutting out the guesswork involved when building an item from scratch.
Nutrient Information – **
They come awfully close to matching SuperTracker in this respect, but MyDietAnalysis falls short since nearly the same information is presented… on several different pages.
Recommendation Information – **
The “Actual Intakes –vs- Recommended Intakes” report shows you just that for all of the nutrients side-by-side. The bar graph is a nice touch, but the scale for percent of goal met could use a little help, given that I didn’t even realize that it was there at first.

MyFitnessPal *½ overall
(free website and mobile application)
Definitely the app most-mentioned by patients and friends who claim to track their eating habits, tempting me to give it a go.
Ease of Use – ***
By far the greatest strength of this program is its availability as a mobile app. Eating lunch out? Just whip out your phone and track it on the spot. Another handy feature puts the foods you eat most often in a checklist immediately under the search box.
Foods Available – *
What I see as both a major weakness and strength of this app is the ability of any user to create foods, which can then be shared community wide. Sure, it’s great for the company, but the problem lies in the room for inaccuracies and errors.
Nutrient Information – *
Disappointingly, only nutrients routinely found on the nutrition facts panel were available. Again accuracy depends upon who actually entered the food into the database.
Recommendations Information – *
Only 6 of the nutrients could be displayed on my homepage at a time, and the printable report doesn’t even include all nutrients available, nor any averages of my intake compared to recommendations.

Final Thoughts
So are any of these inaccuracies, shortcomings, or lack of information harmful? I’d say probably not. The important thing here is that any of these tools can get people aware of what they are eating so that healthy changes can be made. With that I say happy tracking and please discuss in the comment section below.